OBJECTIVE: Surgical decompression is often indicated for symptomatic cases of cervical radiculopathy. In the cervical spine, minimally invasive posterior cervical foraminotomy (MIS-PCF) and the anterior transcorporeal approach (ATCA) are modern techniques available to surgeons. This systematic review and single-arm meta-analysis aimed to assess surgical and patient-reported outcomes of MIS-PCF and ATCA for cervical radiculopathy.
METHODS: A systematic review of the literature was conducted using 1) Ovid; 2) Epub Ahead of Print and In-Process, In-Data-Review & Other Non-Indexed Citations; and 3) Scopus databases, which reported outcomes following cervical decompression using MIS-PCF or the ATCA. Specifically, baseline characteristics, operative outcomes, and changes in visual analog scale (VAS) neck pain score were assessed. The quality of the studies was graded using the modified Newcastle-Ottawa Scale for observational studies.
RESULTS: Forty studies with 1661 patients were identified. The comparative analysis of both techniques revealed no significant differences in complication (7%, 95% CI 5%-10%, p = 0.75) or reoperation rates (5%, 95% CI 3%-7%, p = 0.41). Additionally, there were no significant differences in estimated blood loss (55.39, 95% CI 44.62-66.16 ml, p = 0.55) or operative time (85.15, 95% CI 65.38-104.92 minutes, p = 0.05). The ATCA showed significantly greater improvement (p < 0.01) in VAS neck pain scores following surgery (ATCA point reduction 6.7, 95% CI 6.0-7.5 points vs MIS-PCF 3.0, 95% CI 1.0-5.0 points).
CONCLUSIONS: The ATCA and MIS-PCF are effective modern techniques for the surgical treatment of radiculopathy. Both approaches showed comparable postoperative outcomes, including complication and reoperation rates. However, the ATCA was shown to provide significantly greater improvement in VAS neck pain scores.

BACKGROUND: Minimally invasive cardiac surgery (MICS) has garnered significant attention for its potential benefits, including decreased surgical trauma, accelerated recovery, and improved aesthetic outcomes. This case series aims to elucidate the technical aspects and assess the aesthetic, functional, and quality of life outcomes associated with the utilization of a periareolar incision approach in female patients undergoing cardiac surgery.
METHODS: The periareolar MICS technique, performed with or without high-definition (HD) 3D endoscopic visualization, limited rib-spreading, and a periareolar incision spanning the 3 to 9 o\'clock positions, was employed. We present a case series encompassing five female patients who underwent various cardiac procedures for different pathologies using this approach.
RESULTS: No intraoperative complications occurred, and all patients experienced uneventful postoperative recoveries. The periareolar approach resulted in well-healed incisions with minimal scaring, preserving breast contour and yielding satisfactory cosmetic outcomes. Patients reported negligible pain levels and expressed contentment with the scar appearance.
CONCLUSIONS: The periareolar incision technique in MICS represents an efficacious approach characterized by favorable aesthetic outcomes and enhanced patient experience. Further investigations are warranted to compare different MICS approaches with respect to pain management and their impact on quality-of-life domains.

Pancreas transplant (PTx) is the only treatment that establishes normal glucose levels for patients diagnosed with diabetes types 1 and 2. The paper aims to review and analyze graft survival, patient survival, and the impact on diabetic complications. We describe that the graft survival was 82-98% at 1 year, 90% at 5 years, and 75-54% at 10 years for simultaneous pancreas-kidney recipient; 71% pancreas after kidney (PAK), and 62% PTx alone at 1 year. Patient survival: At 1 year for recipients was 96.9% simultaneous pancreas-kidney transplantation (SPK); for PAK transplantation recipients, 96.3%; and for PTx alone recipients, 98.3%. In general, the pancreas transplantation improves and reverses diabetic complications. Finally, the pancreatic transplant is a morbid procedure and emerges as a significant alternative in diabetes management, directly competing with conventional insulin therapies. Results so far suggest that the most effective transplant model is the SPK. While more patients could benefit from this procedure, surgical complications and the need for immunosuppression pose significant challenges.
El trasplante de páncreas es el único tratamiento que estabiliza los niveles normales de glucosa en los pacientes diagnosticados con diabetes tipo 1 o tipo 2. En esta revisión se analizan la supervivencia del injerto, la supervivencia del paciente y el impacto en las complicaciones diabéticas. Se describe la supervivencia del injerto: 82-98% al año para los receptores de trasplante simultáneo de páncreas y riñón, 71% para trasplante páncreas después de riñón y 62% para trasplante de páncreas solitario al año. Supervivencia de los pacientes a 1 año: 96.9% para los receptores de trasplante simultáneo de páncreas y riñón, 96.3% para los receptores de trasplante de páncreas después de riñón y 98.3% para los receptores de páncreas solitario. En general, el trasplante de páncreas mejora y revierte las complicaciones diabéticas. Finalmente, el trasplante de páncreas, un procedimiento mórbido, surge como una alternativa significativa en el manejo de la diabetes, compitiendo directamente con las terapias convencionales de insulina. Hasta ahora, los resultados indican que el modelo de trasplante más efectivo es el simultáneo de páncreas y riñón. Aunque más pacientes podrían beneficiarse de este procedimiento, las complicaciones quirúrgicas y la necesidad de inmunosupresión plantean desafíos significativos.

OBJECTIVE: Pedicle screw placement guidance is critical in spinal fusions, and spinal surgery robots aim to improve accuracy and reduce complications. Current literature has yet to compare the relative merits of available robotic systems. In this review, the authors aimed to 1) assess the current state of spinal robotics literature; 2) conduct a meta-analysis of robotic performance based on accuracy, speed, and safety; and 3) offer recommendations for robotic system selection.
METHODS: Following PRISMA guidelines, the authors conducted a systematic literature review across PubMed, Embase, Cochrane Library, Web of Science, and Scopus as of April 28, 2022, for studies on approved robots for placing lumbar pedicle screws. Three reviewers screened and extracted data relating to the study characteristics, accuracy rate, intraoperative revisions, and reoperations. Secondary performance metrics included operative time, blood loss, and radiation exposure. The authors statistically compared the performance of the robots using a random-effects model to account for variation within and between the studies. Each robot was also compared with performance benchmarks of traditional techniques including freehand, fluoroscopic, and CT-navigated insertion. Finally, we performed a Duval and Tweedie trim-and-fill test to assess for the presence of publication bias.
RESULTS: The authors identified 46 studies, describing 4670 patients and 25,054 screws, that evaluated 4 different robotic systems: Mazor X, ROSA, ExcelsiusGPS, and Cirq. The weighted accuracy rates of Gertzbein-Robbins classification grade A or B screws were as follows: ExcelsiusGPS, 98.0%; ROSA, 98.0%; Mazor, 98.2%; and Cirq, 94.2%. No robot was significantly more accurate than the others. However, the accuracy of the ExcelsiusGPS was significantly higher than that of traditional methods, and the accuracies of the Mazor and ROSA were significantly higher than that of fluoroscopy. The intraoperative revision rates were Cirq, 0.55%; ROSA, 0.91%; Mazor, 0.98%; and ExcelsiusGPS, 1.08%. The reoperation rates were Cirq, 0.28%; ExcelsiusGPS, 0.32%; and Mazor, 0.76% (no reoperations were reported for ROSA). Operative times were similar for all robots. Both the ExcelsiusGPS and Mazor were associated with significantly less blood loss than the ROSA. The Cirq had the lowest radiation exposure. Robots tended to be more accurate and generally their use was associated with fewer reoperations and less blood loss than freehand, fluoroscopic, or CT-navigated techniques.
CONCLUSIONS: Robotic platforms perform comparably based on key metrics, with high accuracy rates and low intraoperative revision and reoperation rates. The spinal robotics publication rate will continue to accelerate, and choosing a robot will depend on the context of the practice.

Deep brain stimulation (DBS) has emerged as an important therapeutic option for several movement disorders; however, the management of acute complications, such as acute subdural hematoma (ASDH), remains challenging. This is the case of a 71-year-old woman with Parkinson\'s disease who developed ASDH 12 years after bilateral DBS placement. On admission with altered consciousness, imaging revealed significant displacement of the DBS electrodes because of the hematoma. Emergent craniotomy with endoscopic evacuation was performed with preservation of the DBS system. Postoperatively, complete evacuation of the hematoma was confirmed, and the patient experienced significant clinical improvement. ASDH causes significant electrode displacement in patients undergoing DBS. After hematoma evacuation, the electrodes were observed to return to their proper position, and the patient exhibited a favorable clinical response to stimulation. To preserve the DBS electrodes, endoscopic hematoma evacuation via a small craniotomy may be useful.

Metatarsal fractures pose significant challenges in orthopedic practice, necessitating effective treatment methods to ensure optimal patient outcomes. This comprehensive review focuses on intramedullary Kirschner wire fixation as a promising intervention for metatarsal fractures. Beginning with an overview of metatarsal fractures and the imperative for effective treatments, the review delves into intramedullary fixation\'s definition, historical background, advantages, and disadvantages. Indications for its use in metatarsal fractures are discussed, providing a foundation for understanding its application. The surgical technique section outlines critical aspects, including patient selection criteria and preoperative planning. Before presenting a detailed step-by-step procedure for intramedullary Kirschner wire fixation, anesthesia considerations are explored. Emphasizing precision, fluoroscopic guidance, and meticulous postoperative care, this section provides insights for surgeons and healthcare practitioners. Considerations for rehabilitation follow, addressing postoperative care, expected recovery timelines, and physical therapy recommendations. Early mobilization, weight-bearing guidelines, and a structured rehabilitation program play pivotal roles in recovery. In the conclusion, key findings are summarized, highlighting the efficacy of intramedullary Kirschner wire fixation, its advantages, and recommendations for clinical practice. Additionally, areas for future research are identified, guiding further exploration and refinement of this surgical approach. This review is valuable for clinicians, researchers, and healthcare practitioners involved in metatarsal fracture management, contributing to the evolution of treatment strategies and improving patient care.

The \"Letter to the Editor\" titled \"Scalp incision technique for decompressive hemicraniectomy: comparative systematic review and meta-analysis of the reverse question mark versus alternative retroauricular and Kempe incision techniques of published cases\" provides a detailed analysis of different scalp incision techniques in decompressive hemicraniectomy procedures. While commendable for its systematic approach and valuable insights, the letter has several limitations, including a lack of transparency in the search strategy, failure to address potential sources of bias, and a narrow focus on technical aspects without considering broader outcome domains and practical considerations. Despite these limitations, the letter underscores the importance of evidence-based decision-making in neurosurgical practice and calls for further research to address these gaps.

The menisci increase the stability of the tibio-femoral joint, distribute axial load, absorb shock, and provide nutrition and lubrification to the knee articular cartilage. Therefore, is it clear the importance of the meniscus on the overall knee function and the need to preserve it during arthroscopic surgery. However, according to many registry databases, meniscectomy is still the most performed meniscus surgery. In a percentage of patients, knee pain and swelling, as well as bone edema on the tibial plateau, could follow meniscus resection; this constellation of symptoms is known as \"post-meniscectomy syndrome\". If this syndrome is not promptly managed, a rapid worsening of the symptoms and develop of knee osteoarthritis could be expected. While dealing with such condition, the clinician must perform first an accurate clinical examination and a full radiological evaluation. If the patient is candidate for surgery, the replacement of the resected tissue should be performed: a meniscus allograft should be implanted in case of previous total meniscectomy or a meniscus scaffold if the patients has an history of a previous partial resection. The present article represents a comprehensive review of the literature and aims to discuss basic science, preoperative planning and evaluation, indication, surgical technique, and outcomes of the lateral collagen meniscus implant (CMI), a biologic scaffold aimed at replacing partial meniscal defects.

Since the recognition of MPFL as the primary soft-tissue restraint to lateral displacement of the patella, its reconstruction gained popularity either alone or in combination with other procedures. Today, although there are plenty of techniques described in the literature, there is no consensus regarding which one is better. MPFL reconstruction using an endobutton device has been proved to be a reliable option with satisfying clinical results. Single or dual tunnel can be done depending on surgeon\'s preference. For safer outcomes more randomized controlled trials should be done while authors should be more meticulous when it comes to surgical technique.

Introduction: Flexor tendon laceration is often followed by retraction of the proximal stump. The goals of this review were to describe the myriad of proximal stump retrieval surgical techniques and where available to provide the clinical evidence associated with each. Methods: A Medline and Web of Science search was performed to identify any publication whose primary purpose was to describe a tendon retrieval technique. The techniques were assigned to 8 groups. Clinical outcomes, where reported, and advantages and disadvantages of the technique as reported by the authors of the articles were analyzed. Results: Eight-hundred and forty-one publications complied with the search terms, and 33 articles were included in the current analysis. Only 2 of these articles were randomized controlled trials, and they were of low quality. Conclusion: There is no high-quality evidence to allow quantitative comparison of tendon retrieval techniques. An incremental approach can be recommended based on the qualitative review. After failed atraumatic attempts to retrieve the tendon by milking, retrieval should be done through proximal incision at the A1 pulley level, preferably without pulling the tendon out of the wound. When available, using an endoscope to retrieve the tendon appears to be a promising alternative.
Introduction: Une lacération des tendons fléchisseurs est souvent suivie de la rétraction du moignon proximal. Les buts de cette revue étaient de décrire la myriade de techniques chirurgicales de récupération du moignon proximal et, quand cela était possible, de fournir les données probantes cliniques associées à chaque technique. Méthodes: Une recherche dans les bases de données Medline et Web of Science a été réalisée pour identifier toute publication dont l’objectif principal était de décrire une technique de récupération d’un tendon. Les techniques ont été réparties en huit groupes. Les résultats cliniques, quand ils étaient décrits, et les avantages et inconvénients de chaque technique tels que décrits par les auteurs des articles ont été analysés. Résultats: Huit cent quarante et une publications répondaient aux termes de la recherche et 33 articles ont été inclus dans la présente analyse. Seulement deux de ces articles étaient des essais contrôlés randomisés et ils étaient de mauvaise qualité. Conclusion: Il n’existe pas de données probantes de haute qualité qui permettent une comparaison quantitative entre les techniques de récupération des tendons. Une approche incrémentielle peut être recommandée en se basant sur la revue qualitative. Après des tentatives infructueuses de récupération du tendon par succion, la récupération devrait être faite par incision proximale au niveau de la poulie A1, de préférence sans tirer le tendon hors de la plaie. Quand cela est possible, l’utilisation d’un endoscope pour récupérer le tendon semble être une option prometteuse.